Is laser good or bad for melasma?
Laser may improve melasma in selected cases, but it is not a button that erases pigment, and relapse and pigment complications are a real part of the decision. A systematic review of 42 studies on low-fluence Q-switched Nd:YAG laser found possible overall benefit, but stressed large differences between studies, spotty loss of pigment that sometimes lasts, and that aggressive use and high cumulative energy can cause darkening, especially in darker skin. Some studies recorded significant relapse after 3 months, and long-term follow-up was not enough to give one reliable relapse rate.
Key numbers
- 42 studies — Studies in the review
- 3 months — A documented relapse window
- Does not exist — A universal relapse figure
- Spotty loss of pigment — An important complication
When should I consider laser?
- After sun protection and core topical treatment are in place, rather than using laser as an automatic first step.
- With a clear diagnosis of melasma and an assessment of Fitzpatrick skin type and post-inflammatory pigmentation risk, not just because there is brown color on the face.
- When the patient understands that the goal is usually improvement and control, not a permanent cure.
- With a conservative protocol and monitoring for relapse and pigment changes, rather than the idea that more energy gives a better result.
Key takeaways
- Laser can help, but it is not necessarily the first step or the most lasting treatment for melasma.
- Aggressive repetition can cause darkening or spotty loss of pigment instead of improvement.
- If someone gives you one relapse rate for every melasma device and every skin type, that number is not scientific.
Which Laser for Which Problem? CO₂, RF Microneedling and IPL